Chapter Membership Election Report

Chapter Membership Election Report

This report must accompany each list of newly elected Rho Chi members and should be submitted to the
National Office approximately four (4) weeks prior to the planned initiation date. Please complete all
sections applicable to your Chapter.

Chapter Name

College/University

Year

Date of Election

Planned Initiation Date

A. Professional Students: (Doctor of Pharmacy - as the initial Degree)

Total number of students in the current second professional year at the time those students first became eligible for membership

Number of students previously elected into Rho Chi from this class

Number of students elected into Rho Chi from this class at this time*

Total number of students in the current third professional year at the time those students first became eligible for membership

Number of students previously elected into Rho Chi from this class

Number of students elected into Rho Chi from this class at this time*

Total number of students in current fourth professional year at the time those students first became eligible for membership

Number of students previously elected into Rho Chi from this class

Number of students elected into Rho Chi from this class at this time*

Total number of Pharm.D. (as the initial degree) students elected at this time, i.e. the sum of 3., 6. and 9.

B. Professional Students: (Post-Baccalaureate Doctor of Pharmacy)

Total Number of Students elected who are eligible for membership in accord with Bylaws Article III Section 3.(a)

C. Graduate Students:

Total Number of Students elected who are eligible for membership in accord with Bylaws Article III Section 3.(c)

D. Faculty Members:

Total Number of Faculty Members elected who are eligible for membership in accord with Bylaws Article III Section 3.(d)

E. Associate Members:

Total Number of Associate Members elected who are eligible for membership in accord with Bylaws Article III Section 4

Total number of new members elected at this time:(The sum of lines A.10., B., C., D., E., and F. above.)

Total amount paid with this report equal to $65.00 for each new member[Includes: Society Dues ($30.00), Membership Certificates ($5.00), and Official Jewelry ($30.00)]Note: A Membership Certificate and an item of Official Jewelry must be ordered for each newly elected member. (See Article III, Section 10 of the National Bylaws)

This report covers this Chapter’s 1st, 2nd, or 3rd election of new members during the current academic year (September through June). Note: If the Chapter elects new members more than once each year, it is the responsibility of the Faculty Advisor and Dean (or Designee) to assure that the total number of professional students (initial degree) elected in each respective class does not exceed 20%.

Chapter Secretary and Faculty Advisor Certification

We hereby certify that the persons elected as represented in this report have met all requirements set forth in Article III, Section 2, Section 3(a), (b), (c), (d) or Section 4, or Section 5 and Article III, Section 8 of the 2010 Revision of the National Bylaws of the Rho Chi Society.

Signature (Chapter Secretary):

Date:

Signature (Faculty Advisor):

Date:

Dean (or Designee) Certification

I hereby certify that the persons elected as represented in this report have met all requirements set forth in Article III, Section 2, Section 3(a), (b), (c), (d), or Section 4,or Section 5 and Article III, Section 8 of the 2010 Revision of the National Bylaws of the Rho Chi Society. I also certify that these candidates for membership have no known disciplinary action for academic reasons or for unprofessional conduct.

Signature (Dean or Designee):

Date:

Advisor's U.S. Mail Address

Advisor's Name

Advisor's Mailing Address

Advisor's City

Advisor's State

Advisor's zip

Print out the Chapter Membership Election Report. Include one (1) check or money order made payable to The Rho Chi Society in an amount equal to $65.00 for each new member. Send both the printed report and check to the National Office.

*The total number of students elected may not exceed 20% of each respective class, i.e., the sum of lines 2. and 3., of lines 5. and 6., and of lines 8. and 9. may not exceed 20% of lines 1., 4., and 7., respectively.

**The total number of students elected may not exceed 20% of each respective class, i.e., the sum of lines 2. and 3. and of lines 5. and 6. may not exceed 20% of lines 1. and 4., respectively